Adult SVT

Question 1

Adult SVT - Irregular rhythm?

Answer 1

Refer to A-fib / flutter protocol

Question 2

Adult SVT - HR >150 bpm

Answer 2

Vagal maneuver
If unstable skip adenosine and consider cardioversion
Adenosine 12 mg RIVP with flush
OLMC to consider Metoprolol

Question 3

Adult SVT - Chemical or vagal conversion is successful

Answer 3

Treat and refer
or
Transport with supportive care

Question 4

Adult SVT - Treat and refer criteria (7)

Answer 4

18 - 65 years of age
Hx of recurrent SVT
No acute illness
Asymptomatic for 15 min
Did not require cardioversion
No SVT requiring treatment in past 24 hours
Left with a responsible adult for 4 hours

Question 5

Adult SVT - Chemical or vagal conversion unsuccessful and unstable

Answer 5

Cardioversion

* Mandatory OLMC if first cardioversion attempt unsuccessful

Question 6

Adult SVT - Cardioversion dose

Answer 6

100J, 200J, 300J, 360J

Question 7

Adult SVT - Unstable criteria (5)

Answer 7

Altered LOC
Hypotension
Ischemic chest pain
Significant dyspnea
CHF

Question 8

Adult SVT - Formula for HR to consider PSVT

Answer 8

220 – patient’s age

Question 9

Adult SVT - Monitor syncronized but fails to recognize QRS complexes

Answer 9

Adjust the QRS size or switch to another ECG lead

Question 10

Adult SVT - Adenosine indications

Answer 10

SVT

Question 11

Adult SVT - Adenosine dose

Answer 11

12 mg RIVP followed by flush

Question 12

Adult SVT - Adenosine EMS contraindications (7)

Answer 12

Hypersensitivity
Pre-existing 2nd/3rd degree AV block
Sinus node disease (sick sinus syndrome)
Symptomatic bradycardia
Atrial fib/flutter
Active bronchospasm
Patient taking carBAMazepine (Tegretol) or dipyridamole (Persantine)

Question 13

Adult SVT - Adenosine precautions

Answer 13

Adenosine is dangerous in the treatment of atrial fib/flutter

Question 14

Adult SVT - Adenosine administration

Answer 14

Administered rapidly by IV push in a large, proximal vein followed immediately by a rapid NS flush

Question 15

Adult SVT - Adenosine side effects (6)

Answer 15

Metallic taste 
sense of "impending doom” 
facial flushing
light-headedness
diaphoresis
nausea

Question 16

Adult SVT - Chemical or vagal conversion unsuccessful and stable

Answer 16

OLMC

Question 17

Adult SVT - Metoprolol indication?

Answer 17

Mandatory OLMC- PSVT associated with WPW syndrome , known history of recurrent PSVT

Question 18

Adult SVT - Metoprolol dose?

Answer 18

5 mg SIVP x 1

Question 19

Adult SVT - Metoprolol contraindications?

Answer 19

Age of 65 years or greater
Hypersensitivity
Second and third degree AV blocks
Bradycardia less than 50 bpm
Systolic BP less than 100 mmHg
Severe acute heart failure
Bronchospastic COPD, reactive airway disease
Recent (less than 24 hrs) cocaine use